Trauma Surgery Subcatagory Request

[MarineDocFl]

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The short and sweet:

For those of us interested in Trauma Surgery, could we get some love?

 

[MarineDocFl]

There has to be more people that are looking at Trauma Surgery, It's a high-profile and very competitive field. Perhaps if we had a subcatagory dedicated to Trauma Surgery, we could get some people already in the field posting and answering questions.

...Just a thought.

 

[SLUser11]

There has to be more people that are looking at Trauma Surgery, It's a high-profile and very competitive field. Perhaps if we had a subcatagory dedicated to Trauma Surgery, we could get some people already in the field posting and answering questions.

...Just a thought.

It's a good thought, but we simply don't have enough people to support that....just like we don't have CT or Vascular or Surg Onc subforums. I think you can get your trauma questions answered well in the regular surgery forum.

On a side note, I don't think we have any critical care-trained trauma surgeons that post regularly on SDN, but we have several general surgeons who do trauma.

 

[45408]

Very competitive? Is that true? I certainly hadn't heard that was the case.

 

[filter07]

Very competitive? Is that true? I certainly hadn't heard that was the case.

no

 

[Smurfette]

There has to be more people that are looking at Trauma Surgery, It's a high-profile and very competitive field. Perhaps if we had a subcatagory dedicated to Trauma Surgery, we could get some people already in the field posting and answering questions.

...Just a thought.

From what I've seen, usually SDN will create a subcategory when there is a lot of traffic on a topic, i.e. enough traffic to merit it's own (sub)forum. There's not a ton of trauma threads, at least active ones. I agree with the above 'regulars' in here....I think the trauma stuff is generally answered appropriately in the main forum here, and certainly can pull diverse comments from a range of people who may not do solely trauma, but still have something to contribute. This could get lost if trauma posts get buried in a subforum.

I can 'bump it up' for the mod staff to discuss though.

And trauma is not highly competitive...the patient population and lifestyle are not very appealing to most people. Or the 'babysitting' involved.

 

[ESU_MD]

Every general surgeon is a fully trained trauma surgeon by virtue of completing a standard residency. Thus, you already have a forum.

 

[MarineDocFl]

Well, I DO feel more enlightened on the area. My understanding of Trauma Surgery was that you complete a surgical residency, and then move on to a 2 year fellowship.

I suppose I fall into the cliche of Marine Corps embedded hospital corpsman wanting to turn into a trauma guy. Most of my breathern, both active now or separated/retired, tend to gravitate more towards nursing, therefore towards ER nursing or some such. Of course, I have higher aspirations.

I did look at General Surgery and found the aspect of it interesting. The MO, or Medical Officer, that I bug everyday with this stuff tells me that "general surgery is everything 'below the box' and above the legs." There is a lot of real estate in that area, a lot of interesting anatomy and interactions that could keep one facinated for years.

So what we are saying is that General Surgery fully emcompasses Trauma Surgery? And if so, what is the point of the Trauma fellowship?

Thanks for your time 🙂

 

[MarineDocFl]

Also, my understanding was that it IS a highly competitive field. But I am starting to realize that maybe it's because surgery itself is "highly competitive," ergo Trauma Surgery follows suit.

If you could correct my thinking if it is flawed here as well, it would be much appreciated.

 

[LucidSplash]

While General Surgery is not UNcompetitive (it tends to fill all or almost all of its spots yearly without use of the scramble and some otherwise good GS applicants will go unmatched) it is not HIGHLY competitive as a specialty relative to surgical sub-specialties such as urology, orthopedics, neurosurgery, plastics, etc.

However, the top of ANYTHING is competitive within that specialty. So, if you are aiming for a "top" (and the debate on what constitutes top is continuous) GS residency then you will find more competition. The same goes for the "top" critical care/trauma residencies. Matching at Grady or Shock will be different than matching at another less well-known fellowship (which will still provide excellent training). There are currently 7 programs which are certified as Acute Care/Critical Care fellowships (but there is no acute care board at this time). Those 7 programs are somewhat more competitive than others but mostly because they are associated with programs that were already well-known trauma/critical care centers. But as others have stated, one really does not need to critical care/trauma fellowship to work in that field at this time, unless you want to work in a big city at one of the big programs.

As with anything, perspectives and dynamics of the professional world change. So the above may not be true by the time you start looking at a fellowship. But for now, it is not overly difficult to find a critical care fellowship and I would not (even as someone interested in the field) classify it as "highly competitive" unless you are aiming for the most well-known centers.

 

[MarineDocFl]

Thank you all for your considerable input! I look forward to barraging you with questions in the future 🙂

 

[Winged Scapula]

Not much to add to what's already been said but to agree with the following:

1) there is not enough traffic to warrant a sub-forum
2) a Trauma sub-forum will actually dilute the responses and generally lead to *less* input
3) Trauma is a required component of a General Surgery residency
4) the "point" of a trauma fellowship can be either marketing (ie, a potential employer may wish to hire a fellowship trained surgeon), the ability to sell yourself as a Trauma Surgeon (rather than a general surgeon), to spend more time doing Critical Care (as most trauma fellowships have considerable CC time), or for those who don't do a lot of Trauma during residency and want more exposure
5) Trauma fellowships are not competive; IMHO even those most competitive places (such as Shock Trauma, Ryder, etc.) are probably not as competitive as some of the less competitive Plastics/Surg Onc/Peds places
6) General Surgery is not "highly competitive"

 

[Buzz Me]

Well, I DO feel more enlightened on the area. My understanding of Trauma Surgery was that you complete a surgical residency, and then move on to a 2 year fellowship.

As stated above, Trauma isn't very competitive. The bad lifestyle makes it that way. So does the very non-op nature of the field.

And a pure Trauma fellowship (a true "fellowship," as it's not through ACGME) is one-year. Many places combine it with a Critical Care year, which is an ACGME fellowship, to make a total of two years.

But one step at a time. First do well in college, get into a good med school. Then see what you think of your Gen Surg clinical rotations.

Best of luck through this long process!

 

[thedrjojo]

Well, I DO feel more enlightened on the area. My understanding of Trauma Surgery was that you complete a surgical residency, and then move on to a 2 year fellowship.

I suppose I fall into the cliche of Marine Corps embedded hospital corpsman wanting to turn into a trauma guy. Most of my breathern, both active now or separated/retired, tend to gravitate more towards nursing, therefore towards ER nursing or some such. Of course, I have higher aspirations.

I did look at General Surgery and found the aspect of it interesting. The MO, or Medical Officer, that I bug everyday with this stuff tells me that "general surgery is everything 'below the box' and above the legs." There is a lot of real estate in that area, a lot of interesting anatomy and interactions that could keep one facinated for years.

So what we are saying is that General Surgery fully emcompasses Trauma Surgery? And if so, what is the point of the Trauma fellowship?

Thanks for your time 🙂

To be a practicing trauma surgeon, all one has to do is finish a general surgery residency, then get hired. Granted, level one and busy trauma centers (ie, real trauma) are harder to get and pretty much all of those docs are fellowship trained. There is no board for trauma, but there is for critical care, which is one of the major things you get from the fellowship. Most fellowships(if not all) are only 1 year, but there is a push to make them 2 years and make them encompass acute care surgery, the trending model because trauma alone has become so nonoperative that most trauma docs have to take general surgery call. Every year there are unfilled fellowship spots, so the comment of it being very competitive is false. Of course, if you want to fellow at shock, Las Vegas, Miami, etc, those are more competitive. I would recommend you actually do a trauma rotation before you fall in love with trauma. 90% of your patients, you will actually babysitting for ortho or neurosurgery, will never operate on, and will be frustrated with. At my program, which is a big level one trauma in Newark NJ, we get above average operative trauma (plenty of shooting and stabbing) and we have sent 1 person into trauma over the last 10 years (about 75 residents)... Draw your own conclusions.

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[idiot07]

Sorry to hijack the thread, but does anyone else feel that the acute care surgery fellowship is one of the biggest crocks to come along in the history of post residency training? A year for critical care likely unnesscesary if you're going from a cc heavy program, but fine. I'd even buy a year at a super high volume knife and gun club if you didn't feel like you got enough at your general surgery training program, but most people probably do. But to have to spend a year preparing yourself to handle perfed diverticulitis, ischemic bowel, necrotic pancreatitis, and abdominal catastrophe du jour, what did you do during your residency? Is acute care surgery a bad model for practice, no, but you should not need a fellowship to do it.

 

[SLUser11]

Sorry to hijack the thread, but does anyone else feel that the acute care surgery fellowship is one of the biggest crocks to come along in the history of post residency training? A year for critical care likely unnesscesary if you're going from a cc heavy program, but fine. I'd even buy a year at a super high volume knife and gun club if you didn't feel like you got enough at your general surgery training program, but most people probably do. But to have to spend a year preparing yourself to handle perfed diverticulitis, ischemic bowel, necrotic pancreatitis, and abdominal catastrophe du jour, what did you do during your residency? Is acute care surgery a bad model for practice, no, but you should not need a fellowship to do it.

I disagree. Being at a critical-care heavy program shouldn't qualify you to sit for the critical care boards, but spending a year in there as a fellow should....it's just too difficult for the board to ensure residents get an appropriate experience during residency.

You don't need to do a fellowship to be a good acute care surgeon, but I bet it helps. I don't think someone needs to do MIS to do a gastric bypass, but I bet it helps....

I guess what I'm saying is that I don't differentiate between an acute care fellowship and other fellowships in general surgery (Breast, MIS, colorectal, HPB). High volume leads to better outcomes, so spending a year doing something exclusively will make you better at it, especially if done under the guidance of experts in the field.

 

[Atlas Shrugged]

To be a practicing trauma surgeon, all one has to do is finish a general surgery residency, then get hired. Granted, level one and busy trauma centers (ie, real trauma) are harder to get and pretty much all of those docs are fellowship trained. There is no board for trauma, but there is for critical care, which is one of the major things you get from the fellowship. Most fellowships(if not all) are only 1 year, but there is a push to make them 2 years and make them encompass acute care surgery, the trending model because trauma alone has become so nonoperative that most trauma docs have to take general surgery call. Every year there are unfilled fellowship spots, so the comment of it being very competitive is false. Of course, if you want to fellow at shock, Las Vegas, Miami, etc, those are more competitive. I would recommend you actually do a trauma rotation before you fall in love with trauma. 90% of your patients, you will actually babysitting for ortho or neurosurgery, will never operate on, and will be frustrated with. At my program, which is a big level one trauma in Newark NJ, we get above average operative trauma (plenty of shooting and stabbing) and we have sent 1 person into trauma over the last 10 years (about 75 residents)... Draw your own conclusions.



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Why is it the trauma/general surgeons have to babysit for ortho/neuro?

 

[Miami_med]

I think ACS still has some trouble defining exactly what it is. No general surgery program worth its salt should be sending people out into the world without knowing how to handle general surgery emergencies. I don't think that most of the people promoting the ACS fellowship model are using that as the standard. If you look at the few programs currently following this model, there seems to be rotation time spent in HPB and a huge number electives.

My understanding regarding the point of starting such a fellowship was to give surgeons exposure to basic operative ortho, NSGY, and advance operative general surgery to use in a career as a trauma surgeon. The acute care general surgery is really more to maintain operative skills and numbers. Experience is always good, but certainly you could go be a general surgeon in one of the literally hundreds of desperate jobs actively advertising and see appys, choles, strangulated hernias, and perf viscous. These things are so dreadfully common, that covering them will maintain the operative numbers for just about anyone at a large medical center. Most surgeons don't want to deal with these things, and giving them to the trauma surgeon who often needs the operative numbers is sort of a win-win. One does not however need an extra year of fellowship most of the time to handle these things.

Surgical Critical Care is very different. I think many people do not graduate from a general surgey residency with advance SCC skills. This is a discipline that gets a significantly varied amount of attention from program to program. It also really is a sort of sub-discipline, while most of ACS is what you learn in a general surgery residency.

 

[filter07]

In my humble opinion the problem isn't the need to do a year of what you will later do in practice, but the 2-5 years of doing something you'll never do again.

 

[45408]

Why is it the trauma/general surgeons have to babysit for ortho/neuro?

1. Somebody has to admit the patient and has to be the primary service.
2. These patients often do a stint in the SICU first, and trauma is coupled with critical care at many/most places.
3. Ortho/neurosurg aren't going to be managing all the injuries in other body systems.

 

[idiot07]

I don't have a problem with the critical care year, per se. Though I wish there were some way to become board eligible without an extra yea, I agree standardization is difficult. I definitely agree that the acs practice model is good for giving trauma guys work and general surgeons sleep. I know the that the idea of ACS was that trauma surgeons would throw in bolts, femoral nails, etc. but if you look at the rotation schedules for those programs they include maybe a month or to two ortho and maybe a month of nes. This is clearly not enough experience to do those procedures, nor is it feasible in the medical malpractice climate in this country, With regard to the extra HPB and thoracic training, I just think you should get that during gen surg residency, and passing those experience on to fellows only serves to detract from resident education. Thus, I see the ACS fellowship (and not the practice model) as just an excuse to pass off skills that should be taught during residency to fellowship and extend training.

 

[Miami_med]

I don't have a problem with the critical care year, per se. Though I wish there were some way to become board eligible without an extra yea, I agree standardization is difficult. I definitely agree that the acs practice model is good for giving trauma guys work and general surgeons sleep. I know the that the idea of ACS was that trauma surgeons would throw in bolts, femoral nails, etc. but if you look at the rotation schedules for those programs they include maybe a month or to two ortho and maybe a month of nes. This is clearly not enough experience to do those procedures, nor is it feasible in the medical malpractice climate in this country, With regard to the extra HPB and thoracic training, I just think you should get that during gen surg residency, and passing those experience on to fellows only serves to detract from resident education. Thus, I see the ACS fellowship (and not the practice model) as just an excuse to pass off skills that should be taught during residency to fellowship and extend training.

I'd have to agree with this. As I said, the skills taught in the extra year of an ACS fellowship are either things that the surgeon probably won't do, or things that should have already been taught. At my program, I would say that all of my chief's feel comfortable doing all of the foregut work necessary to be an effective trauma surgeon. We are certainly not a huge trauma center. We just have an appropriate amount of exposure to both trauma and HPB for a general surgery residency. I have not had the experience of training at a highly academic medical center. Perhaps the training at some of these places is lacking at the resident level in favor of higher level trainees and the ACS fellowship provides a way to make it up. I would argue however, that his would represent a deficiency in the training at such a program, and it certainly shouldn't generate a new standard for training for everyone else.

I have considered this as a possible career path. It plays to my personal strengths. That being said, I would not consider a two year fellowship. I don't think its necessary, and the training really needs to end eventually. There has to be a point where a new surgeon leaves the nest. I question whether this new model as a training paradigm will really take off. Atleast for right now, using the ACS model could very well be a liability in an attempt to attract qualified candidates. For a program however, it must be great to have a fully trained general surgeon and surgical intensivist on staff for 1/6 of normal salary.

 

[cpants]

I did look at General Surgery and found the aspect of it interesting. The MO, or Medical Officer, that I bug everyday with this stuff tells me that "general surgery is everything 'below the box' and above the legs." There is a lot of real estate in that area, a lot of interesting anatomy and interactions that could keep one facinated for years.

EXCEPT for GU, reproductive system, and anything involving nerves or bones.

Why is it the trauma/general surgeons have to babysit for ortho/neuro?

Politics and laziness mostly. It goes like this: patient gets admitted to trauma after a trauma. Their main problem is neurosurgical or orthopedic, and they go to the OR for that reason. If they have any other injury, however minor, ortho/NS refuses to take the patient because you need to manage that other injury. If it's a truly isolated ortho/neuro issue, you have a prayer, but usually they will sign off in the postop note and disappear. Appeals to take the patient will be met with "we aren't going to do any more surgery, you can discharge the patient, discharge in the AM, etc, etc.". At this point transfer will necessitate an attending to attending conversation. Usually the academic trauma docs don't give a crap because they don't have to answer the pages or do the paperwork to discharge the patient. Thus, the patient gets babysat by the trauma residents until discharge. I imagine this is less of an issue anywhere there is no resident coverage.

A few strategies to combat the consultant passive aggression. If they say no more surgery/issues blah blah blah....tell them there are no other injuries or trauma issues and you will be discharging the patient NOW. That usually gives some pause and might get the ball moving on an appropriate transfer because they usually want at least 24 hours of vascular or neuro checks before you do their discharge paperwork for them. As far as pages from the floor go, I just tell the nurse to call their service directly for any issue related to their injury (within reason of course) -- ie. the cast is too tight, neuro exam is changing. Call me back if you can't get the resident or attending on the phone.

 

[SLUser11]

If they say no more surgery/issues blah blah blah....tell them there are no other injuries or trauma issues and you will be discharging the patient NOW.

While that may occasionally work, it's essentially a game of chicken to see who's willing to be more reckless with the patient's outcome.

I agree that some ortho residents can be total babies about handling isolated orthopedic trauma....probably most, but I don't want to ruffle too many feathers. However, for better and for worse, general surgeons have become the person who will take care of the problem that nobody else wants....as a consultant, it would be silly not to take advantage of that.

 

[doc05]

Why is it the trauma/general surgeons have to babysit for ortho/neuro?

because that's how it works. if you don't like that, don't do trauma.

 

[cpants]

While that may occasionally work, it's essentially a game of chicken to see who's willing to be more reckless with the patient's outcome.

I agree that some ortho residents can be total babies about handling isolated orthopedic trauma....probably most, but I don't want to ruffle too many feathers. However, for better and for worse, general surgeons have become the person who will take care of the problem that nobody else wants....as a consultant, it would be silly not to take advantage of that.

Yeah, I admit it rarely works. It's not necessarily the smartest thing to piss off the trauma team. At one hospital I used to work at it was a huge issue with ortho dumping on the trauma service. It would be patients with isolated ortho injuries, sometimes significant, often without insurance and therefore without placement opportunities for needed rehab/services. Game changed when an ortho trauma service started and they were more than happy to take any ortho patient on service. All of the sudden the general ortho guys went from getting 100% of the trauma consults to 0% in a matter of a few weeks. They were pissed because they lost a huge revenue stream and tried to get added to the trauma call rotation. No one went to bat for them due to their bad behavior over the course of years. Oh, NOW you want our patients? In the real world dumping on your colleagues can have consequences, especially in private practice where there is a chance to choose your consultant. Same scenario happens between general surgery and medicine pretty frequently BTW. Bottom line is do the right thing, because it will catch up to you somehow if you are an ass.